Healthcare Provider Details

I. General information

NPI: 1659492940
Provider Name (Legal Business Name): JOHN MAIORANO R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 RT33
FARMINGDALE NJ
07727
US

IV. Provider business mailing address

123 EAST END AVENUE PO BOX 963
ISLAND HEIGHTS NJ
08732-0963
US

V. Phone/Fax

Practice location:
  • Phone: 732-938-5545
  • Fax:
Mailing address:
  • Phone: 732-288-2998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14331
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: